MEDICARE: MDSLC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	3021	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2145896	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447265863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDSLC INC

Provider Business Mailing Address
First Line	:	116 N MAIN ST
Second Line	:
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-1114
Fax Number	:	308-282-2250

Provider Business Practice Location Address
First Line	:	116 N MAIN ST
Second Line	:
City	:	GORDON
State	:	NE
Zip	:	69343-1524
Country	:	US
Telephone Number	:	308-282-1114
Fax Number	:	308-282-2250

Authorized Official
Title or Position	:	OWNER/PRESIDENT/PIC/AO
Name	:	MICHAEL COOKSTON
Credential	:
Telephone Number	:	308-282-1114

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/19/2018

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Directions to “MDSLC INC ” Practice Location

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